Cognitive Behavioral Therapy for Opioid Use Disorder

Cognitive Behavioral Therapy has been used in a range of settings, including the Veterans Health Administration, primary care settings, and opioid treatment programs. In prior studies, it has commonly been tested as a treatment for substance use or addiction in general and not a specific treatment for opioid use disorder.

Evidence for the intervention

There is moderate quality and heterogeneous evidence for Cognitive Behavioral Therapy for Substance Use Disorder (CBT-SUD). Effect sizes tend to be higher for individuals receiving CBT-SUD for cannabis than for opioids or stimulants, and there have been mixed results when examining the effects of CBT-SUD as an adjunct to medication for opioid use disorder (OUD). A systematic review and meta-analysis published in 2020 concluded “the evidence cautiously suggests that for OUD, there may be some benefit to adding non-individual CBT to buprenorphine therapy.” We therefore give this a rating of yellow.

Evidence-based Scale

Cognitive Behavioral Therapy (CBT) has often been tested as a treatment for substance use or addiction in general and not a specific treatment for opioid use disorder. CBT for substance use has been tested in a range of settings, including primary care settings, opioid treatment programs, and large healthcare systems like the Veterans Health Administration. CBT for substance use typically has modest effects in research studies. Encouragingly, in the largest “real world” implementation of CBT for substance use in the Veterans Health Administration, CBT for substance use was associated with decreased substance use and increased quality of life. The effects of CBT for Opioid Use Disorder (CBT-OUD) have been more mixed in opioid treatment programs that dispense medication, with some studies suggesting it does not have added benefits beyond the effects of medication, and other studies suggesting it has comparable long-term additive benefits as Contingency Management.